DIET,OBESITY AND METABOLIC DISEASE INTRODUCTIONObesity has emerged as apervasive public health problem in the last decade. The disorder manifests asthe abnormal or excessive fat accumulation in adipocytes after an excessivecalorie ingestion through consumption of food that exceeds the body’s metabolicnecessities for growth and development and may impair the health of theindividual. The overweight and obesity can be diagnosed by checking the Bodymass index (BMI), which is a simple index of weight-for-height. It is definedas a person’s weight in kilograms divided by the square of his height in meters(kg/m2) (WHO, 2016). A person with BMI greater than or equal to 25is inferred to be overweight and one with a BMI greater than or equal to 30 isclassified to be obese.
The fundamental reason for this is the imbalancebetween calorie intake and calorie expended by an individual. WHO database showthat, the prevalence of obesity globally was about 13% of the world’s adultpopulation (11% of men and 15% of women) in 2016 and that of metabolic syndrome(MS) is estimated to be between 20-25% and is associated with a two-foldincrease in the risk of coronary heart disease, cerebrovascular disease, and a1.5-fold increase in the risk of all-cause mortality. Thefrequency of obesity got nearly triple folded since 1975, arguably making itthe most serious global epidemic. In 2016, more than 1.9 billion adults, whowere 18 years and older and 41 million children under the age of 5 wereoverweight or obese (WHO, 2016).
Globalization has deeply affected people andthe way they live and eat. It has brought forth a need and urge to consume highcalorie diets from fast food chains. Researches that were conducted on thepossible outcomes and health hazards which includes obesity and other metabolicdisorders, has proved that it is time to start limiting the intake and focusmore on an everyday healthy diet. The prevalence of the metabolic syndrome andcardiovascular disease is expected to rise along with the global obesityepidemic, therefore a greater emphasis should be given to effective earlyweight-management to reduce risk in pre-symptomatic individuals with largewaists (Thang S Han, 2016). OBESITY,CARDIOVASCULAR DISEASES AND METABOLIC SYNDROMEA person can be diagnosed if hehas metabolic syndrome if any 3 among increased waist circumference (?102 cm inmen and ? 88 cm in women elevated triglycerides (?150 mg/dl), reduced HDLcholesterol (<40 mg/dl in men and < 50 mg/dl in women), elevated bloodpressure (?130/85 mm Hg or on treatment for hypertension), or elevated glucose(?100 mg/dl) is present. The discovery of multiple products released fromadipocytes, such as non-esterified fatty acids (NEFAs),inflammatory cytokines, PAI-1, adiponectin and leptin has helped to build theunderstanding of the relation between obesity and metabolic risk factors.NEFAs are formed by lipolysis ofadipose tissue triglycerides. The greater the amount of fat in adipose tissue,the more the amount of NEFAs released will be.
Excessive influx ofnon-esterified fatty acids leads to insulin resistance in the muscles andincreases the triglyceride content of the liver (fatty liver) (Scott M. Grundy,2004).The production of cytokines suchas TNF?, IL-6 is increased in obese persons and this interferes with the actionof insulin to suppress lipolysis. High PAI-1 levels in obese persons due toabnormal abdominal adipose tissue or fatty liver, along with the high plasmafibrinogen observed in such persons contributes to a prothrombotic state. Lowlevels of adiponectin deprive obese patients the anti-inflammatory andantiatherogenic properties necessary to fight against metabolic syndrome.
The most frequently observedcomponent of metabolic syndrome is abdominal obesity (when the waistcircumference is 102 cm or more in men or 88 cm or more in women). Metabolicsyndrome also known as Dysmetabolic syndrome or syndrome X is a major publichealth challenge and is becoming more frequent due to the increased obesityrates among adults in the past three decades. It may become the principal riskfactor for heart disease overtaking smoking which is currently the major riskfactor. DIETARYCHANGESCarbohydrates, fats, andproteins, which are the baseline nutrients are the basis of all lifeactivities. They form the carbon skeleton of various functional molecules, andprovide energy through oxidative decomposition.
The main aim of nutrition ispreventing and treating nutritional deficiencies. However, when nutrition is disproportionate,the body faces the problems of absorption and storage. Over nutrition, can notonly affect health but also cause many ailments such as diabetes,cardiovascular diseases, obesity, hyperlipidaemia and hypertension.Dietary changes in the past 30years are predominantly characterized by increased consumption of animalproducts, refined grains and sugars, due to the increased availability oflow-cost food and drinks, which are often low in nutritional value and high inenergy and sugar.
Citing an example, global per capita food consumption was 2358kcal per capita per day in the year 1965, andincreased to a 2655 in 1985 and a shocking 2940 kcalper capita per day in 2015. It is expected to reach 3050 kcal percapita per day by 2030. Furthermore, calories of different materials are notthe same depending on the metabolic pathways, like protein requires a higher energyto get metabolize than fats and carbohydrates.
As many countries started to experiencerapid economic growth changes to food choice and availability brought about byurbanization was inevitable, causing overnutrition. These conversions are alsofuelled by reductions in prices of low-quality foods that are high in energyand increases in gross domestic product, which are indicative of higher familyincome and greater purchasing power. Fast food has been linked to obesity, cardiacand metabolic disease for a number of reasons, including high calorie content, hugeportion sizes, high amounts of processed meat, very refined carbohydrates,sugary beverages, unhealthy fats, and unhealthy levels of salt and sugar.
The presence of overweight andobesity is directly linked to the prevalence of metabolic syndrome,cardiovascular disease and type 2 diabetes. This relationship is one of cause(overweight/obesity) and effect (metabolic disease). Therefore, if added sugarconsumption promotes body fat gain relative to other macronutrients, this is asecond and indirect pathway by which high sugar diets may contribute to thedevelopment of metabolic disease (Kimber L. Stanhope 2015).
ADDEDSUGARSAdded sugar at commonly-consumedlevels does not have a huge effect on the weight gain as per, but big on thedevelopment of metabolic disease as we devour sugar treats almost every day invariant forms. Sugar is not simply a source of extra calories. It is a directcontributor to the development of metabolic disease.
But some sugars pose agreater threat compared to their counterparts. Excessive fructose ingestingespecially in combination with surplus energy intake does have adverse effectson metabolic health, comparing glucose and fructose, glucose can be metabolizedby all the body’s tissues, but fructose can only be metabolized by the liver inany significant amount. Moreover, fructose from added sugars leads to higherghrelin levels also known as “hunger syndrome”, reduced satiety, insulinresistance, fat gain in the abdominal region, increased triglycerides and bloodsugar and small, dense low-density lipopolysaccharides compared to similarnumber of calories from glucose. This knowledge and understanding will be moreeffective in slowing our epidemics of metabolic disease. OBESITYMANAGEMENTObesity management is expensive and,along with diabetes, obesity is a disease that needs to be defused. Medicalcosts rise progressively as BMI increases and are expected to continue to risein the next 15 years.
Obesity shortens life span and affects the function ofmany organ systems. Mortality results from several diseases that are associatedwith obesity, including diabetes, chronic kidney disease, gastrointestinaldisease, and cardiovascular disease and maintaining weight loss is oftendifficult or unsuccessful. The first and foremost thing to manage obesity is tocontrol the diet and to consume appropriate foods. According to a study by ProfGeorge Bray MD, the energy intake should be reduced by 500 kcal/day belowenergy requirements or must use a dietary plan that has 1200–1500 kcal/day forwomen or 1500–1800kcal/day for men (increased by a further 300 kcal/day foreach sex if weight exceeds 150 kg) (Prof George Bray MD,2016).Even though, obesity is highlypreventable, the measures taken to control it is not as effective as it isneeded to be. When it cannot be prevented, treatment on various levels must beindicated.
Physical activity, providesonly a small effect on weight reduction, still, it is an important part ofobesity management by conservation of the fat-free mass during severe weightloss and additionally it helps to encourage weight maintenance. It increases cardiorespiratoryfitness. Physical activity counselling includes advice on both habitualphysical activity in everyday life and structured supervised exercise. Exerciseprescription must focus on a gradual increase to levels that are safe for thepatient. The prescription should be tailor made for each patient.Dietary Prescriptions and dietarymodifications should be custom made. Moreover, it can be used to help the patientidentify insights and beliefs about cognition (emotional eating behaviour) and behaviour(eating habits).
The management of eating disorders also appears as animperative before reduction in energy intake. Weight maintenance would need spasmodictreatment with formula diet or drug remedies.Pharmacotherapy shouldbe considered as part of an all-inclusive strategy of disease management. Itcan help to prevent the development of obesity co-morbidities (e.
g. hypertension,type II diabetes mellitus). Current drug therapy is suggested only for patientswith a BMI ? 30 kg/m2 along with an obesity-associated disease (e.g.hypertension or type II diabetes mellitus). Medicines should be used accordingto their licensed warnings and restrictions.
Whether the therapy is useful ornot should be evaluated by the first 3 months and treatment should be sustainedonly if weight loss achieved is considered reasonable (approximately 5% weightloss in people without and 3% in patients with diabetes). Progresses in waistcircumference reduction should be used as alternative, more genuine indicatorfor accomplishment. Treatment should be discontinued in non-responders.
One ofthe approved available drugs for weight management in Europe is Orlistat, whichis a triglyceride lipase inhibitor and it decreases fat absorption by 30%. It contributesa modest effect to the lifestyle intervention when paired with hypocaloriclow-fat diet. Several other drugs are currently tested in clinical trials forweight management worldwide. Soon such medicines are hoped to help bridge thegap between existing treatment options and needs of the patients.
Bariatric surgery, whenused in carefully selected patients is the most effective measure for inducingsubstantial weight loss. It is a part of a lifelong weight management programmeand might have a follow-up of medical complications. Current evidence points tochief benefits in terms of prevention of type II diabetes, cardiovascular risk reductionand cancer reduction (mostly in women), and suggests increased longevity. Themost frequently used surgical techniques now are adjustable gastric banding, sleevegastrectomy, Roux-en-Y gastric bypass, biliopancreatic diversion or combinedoperations such as biliopancreatic diversion with duodenal switch.
Proper communicationwith the patient is essential regarding the risk-benefit ratio and anexperienced multidisciplinary team including the surgeon should cautiouslyaccess the selection of the right patient for the procedure. RECOMMENDATIONSStrategies to address the globalobesity epidemic require sustained, population-wide intercessions and policy approvalsdesigned to improve diet and upsurge physical activity using a multilevelsystems approach. Battling obesity requires synchronized efforts from theinternational community, governments, industries, health-care providers,schools and universities, urban planners, agricultural and service sectors, themedia, communities and individuals. The agricultural and service sector can putforth nutritional and agricultural policies, which can be powerful instrumentsfor preventing obesity if they are aligned with evidence-based national dietarygoals.Legislation for removal of transfats from the food supply is an important factor and it should be enacted alongwith replacing partially hydrogenated oils with oils that include omega-3 fattyacids.
Thisinitiative should be supported by government regulation, which could include inducementsfor the production and use of oils that are healthier, but this approach wouldrequire the agricultural and food industry sectors to work together. Implementationof taxes on unhealthy foods and beverages must be indorsed by the government,as well as the design and execution of food pricing policies, such asagricultural subsidies, should stress the need to increase availability andaffordability of fruits, vegetables, legumes, nuts and whole grains. Thegovernmentsshould also encourage use of public transportation and bicycles by providingincentives including discounted transportation fares, and secure bicycleparking along with implementing taxes. Voluntary actions andregulations (labelling calorie and nutrient content of foods) made by industrycould be beneficial policies for improving diet quality both nationwide andworldwide.Growth in food marketing andadvertising, has created major shifts in food demand as marketing leads peopleespecially children to increase their consumption of advertised products. Forthis reason, the WHO recommends that governments and industry decrease the advertisingand marketing of unhealthy foods and to improve the school meal programmes andpolicies related to vending machines are influential tools to address childhoodobesity along with nutritional education about healthy diet and education aboutactive lifestyles. Make sure to deliver educational pamphlets to parents forinformed dietary choice.
Public-health messages abouthealthy diet and lifestyle need to reach far and wide and this can only bepossible with the help of the mass media and public service campaigns, like Change4Lifein England, which aims in supporting people to make healthier choices about activityand food. CONCLUSIONObesity has become aninternational public health issue that affects the HALYs, risk of morbidity,and raises health economics in countries all over the world. Anindividual does not become obese acutely, it is likely that the risk factorsexist considerably long before evident indications of the metabolic syndromeand cardio vascular disease are expressed. Some individuals carry the risk froma very early age because of childhood obesity, while others do not reflect ituntil later in life. Therefore, it becomes matter of importance to provide riskinhibition to pre-symptomatic individuals. Proper awareness must be spreadto the public, to eradicate any lingering myths and misconceptions regardingthe risk factors of obesity, how two calories are not the same and how diet andadded sugars affect metabolism. Social inequalities andstigmatization resulting in discrimination is very high for the obese patients.Reducing weight stigma and access promotion to healthier lifestyle options are thetwo vital points in management of the weight.
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